Outcome analysis after one year of uncemented THA done for neglected acetabular fractures

Introduction - Acetabular fractures mostly occur in young middle aged patients due to high energy trauma. Best results have been obtained by total hip arthroplasty compared to other forms of treatment in selected cases. THA requires acetabular reconstruction and bone grafting. Limb length discrepancy needs to be addressed-due to proximal femoral migration protrusio acetabulum. Early cases where fragments are loose can be managed with cage with bone grafts where as late cases where as fragments are sticky needs to be reconstructed with jumbo cups and bone grafts. Aim of the study - The purpose of this study was to focus on the outcome of impacted bulk or morselized cancellous grafts with cementless hemispherical components in the presence of cavitary acetabular defects in primary total hip arthroplasties. Materials methods Three cases of neglected acetabulum fractures presented to us in the state of non union have been treated with primary cementless total hip arthroplasty with autograft substitution and followed up for outcome for a period of 12 months. Results have been outlined using modified harris hip score. Results - Uncemented THA preferred as most patients are young. Cavitary acetabular defects requires placement of structural cortical or morcelised cancellous graft harvested from patients own resected femoral head. Greater than two-thirds rim fit of the cup to host bone was obtained in all cases. Additional screw augmentation done in all three cases. The average hip score was increased from preoperative mean of 40 to a postoperative mean of 86. All three patients are fuctionally doing well without pain and disability during the period of follow-up study. Conclusion - Total hip arthroplasty is a procedure of choice in neglected acetabulum fractures and limb length discrepancy can be addressed through both femoral and acetabular side. Cavitary defects can be managed successfully by using bulk or morcelised cancellous autograft. Cementless cups are generally accepted to be a viable option for primary as well as revision hip arthroplasties specially in young patients.